BACKGROUND: Indications for the treatment of osteochondritis
dissecans of the humeral capitellum have remained unclear. The aims of this
study were to analyze the outcomes and to determine the most useful
classification for the choice of treatment.
METHODS: The cases of 106 patients with osteochondritis dissecans of
the capitellum were studied retrospectively. At the time of the initial
presentation, the mean age of the patients was 15.3 years. The capitellar
growth plate was open in eighteen patients and closed in eighty-eight.
Thirty-six patients were treated nonoperatively. Fifty-five patients underwent
fragment removal alone, twelve underwent fragment fixation with a bone graft,
and three underwent reconstruction of the articular surface with use of
osteochondral plug grafts from the lateral femoral condyle. The mean follow-up
period was 7.2 years. The outcomes in terms of pain in the elbow, return to
sports, and radiographic findings were analyzed and compared.
RESULTS: An osteochondritis dissecans lesion with an open capitellar
physis and a good range of elbow motion resulted in a good outcome. Continued
elbow stress resulted in the worst outcome in terms of pain and radiographic
findings. In patients with a closed capitellar physis, surgery provided
significantly better results than elbow rest (p < 0.01). Fragment fixation
or reconstruction provided significantly better results than fragment removal
alone (p < 0.05). The results of removal alone were dependent on the size
of the defect in the capitellum. The outcome in terms of pain was closely
associated with sports activity and radiographic findings.
CONCLUSIONS: We believe that osteochondritis dissecans of the
capitellum can be classified as stable or unstable. Stable lesions that healed
completely with elbow rest had all of the following findings at the time of
the initial presentation: an open capitellar growth plate, localized
flattening or radiolucency of the subchondral bone, and good elbow motion.
Unstable lesions, for which surgery provided significantly better results, had
one of the following findings: a capitellum with a closed growth plate,
fragmentation, or restriction of elbow motion of =20°. For large
unstable lesions, fragment fixation or reconstruction of the articular surface
leads to better results than simple excision.
LEVEL OF EVIDENCE: Prognostic Level II. See Instructions to Authors
for a complete description of levels of evidence.
ORIGINAL ABSTRACT CITATION: "Classification, Treatment, and Outcome
of Osteochondritis Dissecans of the Humeral Capitellum"